Prevalence of adolescent mental disorders in Kenya, Indonesia, and Viet Nam measured by the National Adolescent Mental Health Surveys (NAMHS): a multi-national cross-sectional study.

BACKGROUND: Mental disorders are the leading global cause of health burden among adolescents. However, prevalence data for mental disorders among adolescents in low-income and middle-income countries are scarce with often limited generalisability. This study aimed to generate nationally representative prevalence estimates for mental disorders in adolescents in Kenya, Indonesia, and Viet Nam. METHODS: As part of the National Adolescent Mental Health Surveys (NAMHS), a multinational cross-sectional study, nationally representative household surveys were conducted in Kenya, Indonesia, and Viet Nam between March and December, 2021. Adolescents aged 10-17 years and their primary caregiver were interviewed from households selected randomly according to sampling frames specifically designed to elicit nationally representative results. Six mental disorders (social phobia, generalised anxiety disorder, major depressive disorder, post-traumatic stress disorder, conduct disorder, and attention-deficit hyperactivity disorder) were assessed with the Diagnostic Interview Schedule for Children, Version 5. Suicidal behaviours and self-harm in the past 12 months were also assessed. Prevalence in the past 12 months and past 4 weeks was calculated for each mental disorder and collectively for any mental disorder (ie, of the six mental disorders assessed). Prevalence of suicidal behaviours (ie, ideation, planning, and attempt) and self-harm in the past 12 months was calculated, along with adjusted odds ratios (aORs) to show the association with prevalence of any mental disorder in the past 12 months. Inverse probability weighting was applied to generate national estimates with corresponding 95% CIs. FINDINGS: Final samples consisted of 5155 households (ie, adolescent and primary caregiver pairs) from Kenya, 5664 households from Indonesia, and 5996 households from Viet Nam. In Kenya, 2416 (46·9%) adolescents were male and 2739 (53·1%) were female; in Indonesia, 2803 (49·5%) adolescents were male and 2861 (50·5%) were female; and in Viet Nam, 3151 (52·5%) were male and 2845 (47·4%) were female. Prevalence of any mental disorder in the past 12 months was 12·1% (95% CI 10·9-13·5) in Kenya, 5·5% (4·3-6·9) in Indonesia, and 3·3% (2·7-4·1) in Viet Nam. Prevalence in the past 4 weeks was 9·4% (8·3-10·6) in Kenya, 4·4% (3·4-5·6) in Indonesia, and 2·7% (2·2-3·3) in Viet Nam. The prevalence of suicidal behaviours in the past 12 months was low in all three countries, with suicide ideation ranging from 1·4% in Indonesia (1·0-2·0) and Viet Nam (1·0-1·9) to 4·6% (3·9-5·3) in Kenya, suicide planning ranging from 0·4% in Indonesia (0·3-0·8) and Viet Nam (0·2-0·6) to 2·4% (1·9-2·9) in Kenya, and suicide attempts ranging from 0·2% in Indonesia (0·1-0·4) and Viet Nam (0·1-0·3) to 1·0% (0·7-1·4) in Kenya. The prevalence of self-harm in the past 12 months was also low in all three countries, ranging from 0·9% (0·6-1·3) in Indonesia to 1·2% (0·9-1·7) in Kenya. However, the prevalence of suicidal behaviours and self-harm in the past 12 months was significantly higher among those with any mental disorder in the past 12 months than those without (eg, aORs for suicidal ideation ranged from 7·1 [3·1-15·9] in Indonesia to 14·7 [7·5-28·6] in Viet Nam). INTERPRETATION: NAMHS provides the first national adolescent mental disorders prevalence estimates for Kenya, Indonesia, and Viet Nam. These data can inform mental health and broader health policies in low-income and middle-income countries. FUNDING: The University of Queensland in America (TUQIA) through support from Pivotal Ventures, a Melinda French Gates company.

"Our program manager is a woman for the first time": perceptions of health managers on what workplace policies and practices exist to advance women's career progression in the health sector in Kenya.

BACKGROUND: Existing evidence suggests that organisation-level policies are important in enabling gender equality and equity in the workplace. However, there is little research exploring the knowledge of health sector employees on whether policies and practices to advance women's career progression exist in their organisations. In this qualitative study, we explored the knowledge and perspectives of health managers on which of their organisations' workplace policies and practices contribute to the career advancement of women and their knowledge of how such policies and practices are implemented and monitored. METHODS: We employed a purposive sampling method to select the study participants. The study adopted qualitative approaches to gain nuanced insights from the 21 in-depth interviews and key informant interviews that we conducted with health managers working in public and private health sector organisations. We conducted a thematic analysis to extract emerging themes relevant to advancing women's career progression in Kenya's health sector. RESULTS: During the interviews, only a few managers cited the policies and practices that contribute to women's career advancement. Policies and practices relating to promotion and flexible work schedules were mentioned most often by these managers as key to advancing women's career progression. For instance, flexible work schedules were thought to enable women to pursue further education which led to promotion. Some female managers felt that women were promoted to leadership positions only when running women-focused programs. There was little mention of capacity-building policies like training and mentorship. The health managers reported how policies and practices are implemented and monitored in general, however, they did not state how this is done for specific policies and practices. For the private sector, the health managers stated that implementation and monitoring of these policies and practices is conducted at the institutional level while for the public sector, this is done at the national or county level. CONCLUSIONS: We call upon health-sector organisations in Kenya to offer continuous policy sensitisation sessions to their staff and be deliberate in having supportive policies and other pragmatic interventions beyond policies such as training and mentorship that can enable women's career progression.

"I was tricked": understanding reasons for unintended pregnancy among sexually active adolescent girls.

BACKGROUND: While the Kenya government is mobilizing high-level strategies to end adolescent pregnancy by 2030, a clear understanding of drivers of early unintended pregnancy in the country is a necessary precursor. In this study, we determine the prevalence, associated factors, and reasons for unintended pregnancy among sexually active adolescent girls (aged 15-19 in two Kenya counties with the highest rate of teenage pregnancy. METHODS: We used the "In Their Hands" (ITH) program's baseline evaluation data. The study adopted a mixed-methods design with 1110 sexually active adolescent girls in the quantitative component and 19 girls who were either pregnant or nursing a child in the qualitative. We used adjusted and unadjusted logistic regression to model factors associated with unintended pregnancy among respondents. We used a thematic analysis of qualitative data to examine girls' reasons for having unintended pregnancy. RESULTS: Overall, 42% of respondents have had an unintended pregnancy; however, higher proportions were observed among girls who were 19 years (49.4%), double orphans (53.6%), never used contraceptive (49.9%), out-of-school (53.8%), and married (55.6%). After adjusting for relevant covariates, the odds of unintended pregnancy were higher among girls who resided in rural areas (AOR 1.64, 95% CI 1.22-2.20), had primary or no formal education (AOR 1.50 95% CI 1.11-2.02), and had never used contraceptive (AOR 1.69 95% CI 1.25-2.29) compared with their counterparts. Current school attendance was associated with a 66% reduction in the probability of having an unintended pregnancy. Participants of the qualitative study stated that the desire to maintain a relationship, poor contraceptive knowledge, misinformation about contraceptive side effects, and lack of trusted mentors were the main reasons for their unintended pregnancies. CONCLUSION: A massive burden of unintended pregnancy exists among sexually active adolescent girls in the study setting. Adolescent boys and girls need better access to sexuality education and contraceptives in the study setting to reduce early unintended pregnancy.

RéSUMé: CONTEXTE: Alors que le gouvernement kenyan déploie des stratégies de haut niveau pour mettre fin aux grossesses chez les adolescentes d'ici 2030, il est nécessaire de bien cerner les facteurs qui favorisent les grossesses précoces non planifiées dans le pays. Dans cette étude, nous déterminons la prévalence, les facteurs associés et les causes des grossesses non planifiées chez les adolescentes sexuellement actives (âgées de 15 à 19 ans) dans deux comtés du Kenya où le taux de grossesse adolescente est le plus élevé. MéTHODOLOGIE: Nous avons utilisé les données d'évaluation de base du programme « In Their Hands ¼ (ITH). L'étude a adopté une approche mixte comprenant 1110 adolescentes sexuellement actives dans la composante quantitative et 19 adolescentes enceintes ou allaitantes dans la composante qualitative. Nous avons utilisé une régression logistique ajustée et non ajustée pour modéliser les facteurs associés à une grossesse non planifiée chez les répondantes. Pour ce qui est des données qualitatives, nous avons procédé à une analyse thématique afin d'examiner les facteurs expliquant les grossesses non planifiées chez les filles. RéSULTATS: Globalement, 42 % des répondantes ont vécu une grossesse non planifiée ; toutefois, des proportions plus élevées ont été observées chez les filles âgées de 19 ans (49,4 %), celles doublement orphelines (53,6 %), celles qui n'ont jamais utilisé de moyens contraceptifs (49,9 %), celles non scolarisées (53,8 %) et chez celles qui étaient mariées (55,6 %). Après ajustement des covariables pertinentes, les probabilités de grossesse non planifiée étaient plus élevées chez les filles qui résidaient dans des zones rurales (AOR:1,64, IC 95%:1,22-2,20), avaient un niveau d'éducation primaire ou aucune éducation formelle (AOR:1,50 IC 95%:1,11-2,02), et n'avaient jamais utilisé de contraceptifs (AOR:1,69 IC 95%-1,25-2,29) par rapport à leurs congénères. La fréquentation scolaire actuelle était associée à une réduction de 66 % de la probabilité d'être confrontée à une grossesse non planifiée. Les participantes à l'étude qualitative ont déclaré que le désir d'entretenir une relation, une mauvaise connaissance des contraceptifs, de fausses informations sur les effets secondaires des contraceptifs et le manque de mentors de confiance étaient les principales raisons de leurs grossesses non planifiées. CONCLUSION: Un lourd fardeau lié aux grossesses non désirées existe parmi les adolescentes sexuellement actives de la zone étudiée. Les adolescents, garçons et filles, doivent avoir un meilleur accès à l'éducation sexuelle et aux contraceptifs dans la zone étudiée afin de réduire les grossesses non planifiées précoces.

Interventions for improving the health and socioeconomic well-being of young parents in Africa: a systematic review protocol.

INTRODUCTION: Early childbearing is highly prevalent in Africa. Despite the harmful consequences of early childbearing on young people, there is limited documentation of interventions that aim to improve the health and socioeconomic well-being of young parents on the continent. In this systematic review, we will map and provide a critical synthesis of interventions that aim to improve the health and socioeconomic well-being of young parents in Africa to inform future policy and programmatic decision-making. METHODS AND ANALYSIS: The systematic review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We will conduct an electronic search of peer-reviewed articles published in six databases: PubMed, Science Direct, AJOL, JSTOR, ERIC and Google Scholar. We will also search for grey literature through Google search and organisations' websites to broaden the number of interventions retrieved. Articles will be included if (1) the study participants are young mothers and fathers aged 10-24 years, (2) the article reports on interventions targeting young mothers and fathers in Africa or individual countries in Africa, (3) the article is published in English or French, (4) the article reports on health and socioeconomic well-being outcomes and (5) the article was published between 1 January 2000 and 31 December 2023. We will extract relevant information from articles that meet the inclusion criteria and synthesise data using both quantitative and qualitative approaches. Two reviewers will independently screen articles for inclusion, extract data from included articles and assess the methodological quality of studies. ETHICS AND DISSEMINATION: Ethical approval is not required for the systematic review since we are synthesising publicly available publications. Findings from this systematic review will be published in a peer-reviewed journal and further disseminated in conferences and convenings focusing on the health and socioeconomic well-being of young parents. PROSPERO REGISTRATION NUMBER: CRD42023464828.

Legislation for advancing women's leadership in the health sector in India and Kenya: a 'law cube' approach to identify ways to strengthen legal environments for gender equality.

OBJECTIVES: This paper examines the availability of legal provisions, or the lack thereof, that support women to progress equitably into leadership positions within the health workforce in India and Kenya. METHODS: We adapted the World Bank's Women, Business and Law framework of legal domains relevant to gender equality in the workplace and applied a 'law cube' to analyse the comprehensiveness, accountability and equity and human rights considerations of 27 relevant statutes in India and 11 in Kenya that apply to people in formal employment within the health sector. We assessed those laws against 30 research-validated good practice measures across five legal domains: (1) pay; (2) workplace protections; (3) pensions; (4) care, family life and work-life balance; and (5) reproductive rights. In India, the pension domain and related measures were not assessed because the pension laws do not apply to the public and private sector equally. RESULTS: Several legal domains are addressed inadequately or not at all, including pay in India, reproductive rights in Kenya and the care, family life and the work-life balance domain in both countries. Additionally, we found that among the Kenyan laws reviewed, few specify accountability mechanisms, and equity and human rights measures are mainly absent from the laws assessed in both countries. Our findings highlight inadequacies in the legal environments in India and Kenya may contribute to women's under-representation in leadership in the health sector. The absence of specified accountability mechanisms may impact the effective implementation of legislation, undermining their potential to promote equal opportunities. CONCLUSIONS: Government action is needed in both countries to ensure that legislation addresses best practice provisions, equity and human rights considerations, and provides for independent review mechanisms to ensure accountability for implementation of existing and future laws. This would contribute to ensuring that legal environments uphold the equality of opportunity necessary for realising gender justice in the workplace for the health workforce. PRIMARY SOURCE OF FUNDING: Bill & Melinda Gates Foundation (INV-031372).

Pathways to leadership: what accounts for women's (in)equitable career paths in the health sectors in India and Kenya? A scoping review.

OBJECTIVES: We aimed to capture evidence on enablers and barriers to improving equal opportunity and effective organisational interventions that can advance women's leadership in India and Kenya's health sectors. METHODS: We systematically searched JSTOR, PubMed, SCOPUS and Web of Science databases, reference lists of selected articles and Google Scholar using string searches. We included studies that were published in English from 2000 to 2022 in peer-reviewed journals or grey literature, focused on paid, formal health professionals in India or Kenya, described factors relating to women's representation/leadership. RESULTS: We identified 26 studies, 15 from India and 11 from Kenya. From each country, seven studies focused on nursing. Participants included women and men health sector workers. Seven studies used mixed methods, 11 were qualitative, 5 were quantitative and 3 were commentaries. Factors influencing women's career progression at individual/interpersonal levels included family support, personal attributes (knowledge/skills) and material resources. Factors at the organisational level included capacity strengthening, networking, organisational policies, gender quotas, work culture and relationships, flexibility, and work burden. Nursing studies identified verbal/sexual harassment and professional hierarchies as barriers to career progression. Structural barriers included a lack of infrastructure (training institutes and acceptable working environments). Normative themes included occupational segregation by gender (particularly in nursing), unpaid care work burden for women and gender norms. Studies of interventions to improve women's career progression and sex-disaggregated workforce data in India or Kenya were limited, especially on leadership within career pathways. The evidence focuses on enablers and barriers at work, rather than on organisations/systems to support women's leadership or address gender norms. CONCLUSIONS: Women in India and Kenya's health sectors face multiple impediments in their careers, which impact their advancement to leadership. This calls for gender-transformative interventions to tackle discrimination/harassment, provide targeted training/mentorship, better parental leave/benefits, flexible/remote working, family/coworker support and equal-opportunity policies/legislation.